A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults

Background

Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults.

Methods

A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined.

Results

In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies.

Conclusions

To date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults.

     

The affective and cognitive context of self-reported measures of subjective well-being

Researchers attempting to understand the experience of subjective well-being have relied heavily on self-report measurement. Recent research focused on this method has demonstrated that a number of factors, such as the current mood of the respondent and the cognitive and social context surrounding the response, can significantly influence response to items inquiring about global subjective well-being or satisfaction with life. In the present study, several measurement strategies (e.g., single-item measures, multiple-item scales, and memory search tasks) were compared with regard to their susceptibility to such influences. Although some evidence for effects due to item-placement or transient mood were found, all of the global measures of subjective well-being and life satisfaction has significant convergence with peer-reports, and the single-item measures showed good temporal reliability across a one-month interval. The data provide evidence for a significant degree of stability in subjective well-being and life satisfaction.     

The relationship between income and subjective well-being: Relative or absolute?

Although it appears that income and subjective well-being correlate in within-country studies (Diener, 1984), a debate has focused on whether this relationship is relative (Easterlin, 1974) or absolute (Veenhoven, 1988, 1991). The absolute argument advanced by Veenhoven states that income helps individuals meet certain universal needs and therefore that income, at least at lower levels, is a cause of subjective well-being. The relativity argument is based on the idea that the impact of income or other resources depends on changeable standards such as those derived from expectancies, habituation levels, and social comparisons. Two studies which empirically examine these positions are presented: one based on 18 032 college studies in 39 countries, and one based on 10 year longitudinal data in a probability sample of 4 942 American adults. Modest but significant correlations were found in the U.S. between income and well-being, but the cross-country correlations were larger. No evidence for the influence of relative standards on income was found: (1) Incomechange did not produce effects beyond the effect of income level per se, (2) African-Americans and the poorly educated did not derive greater happiness from specific levels of income, (3) Income produced the same levels of happiness in poorer and richer areas of the U.S., and (4) Affluence correlated with subjective well-being both across countries and within the U.S. Income appeared to produce lesser increases in subjective well-being at higher income levels in the U.S., but this pattern was not evident across countries. Conceptual and empirical questions about the universal needs position are noted. Suggestions for further explorations of the relativistic position are offered.     

School readiness of low-income children at risk for school failure

The goal of this research project was to gain information about the readiness skills of kindergarten children in 11 inner city schools with the highest poverty rates in the Salt Lake City School District. Kindergarten teachers and principals in these schools were interviewed regarding their perceptions of the readiness skills needed for these children to be successful in their schools. A summary of the readiness skills of the kindergarten children was derived from a state mandated Pre-Kindergarten Assessment. Most principals stressed children's social and emotional development as a priority in school readiness. The majority of teachers emphasized literacy as a prerequisite for school success. Yet, the Pre-Kindergarten Assessment revealed that one fourth of the children could not identify the front of a book and two thirds of the children did not know where to start or which direction to go when reading. Half of the parents of these children reported that they rarely read to their children and that they had only visited a library once or not at all. The gap between the readiness skills educators think these children need and the skills children enter school with presents a serious problem for educators and policy makers. Multiple intervention strategies are recommended including providing education and home activities to enhance children's readiness skills, coordinating access to early childhood programs, and educating parents on available community resources.     

Attachment to Mothers and Fathers during Middle Childhood: Associations with Child Gender, Grade, and Competence

Attachment relationships of first, third, and fifth graders with their mothers and fathers, and their associations with self‐perceived and teacher‐rated competence, were investigated. Children rated their attachment security with mothers and fathers using the Kerns security scale. Children's perceptions of academic and peer competence were measured using Harter's self‐perception profile, and teachers also rated children's competence. Girls felt greater attachment security to their mothers than to their fathers, and boys felt greater attachment security to their fathers than did girls. Greater attachment security with both mothers and fathers was associated with children's perceptions of greater peer and academic competence, and this association was stronger for older children. A greater sense of attachment security with both parents was associated with greater competence than a sense of attachment security with only one parent. Teacher‐rated competence was significantly related to attachment security with mothers but not fathers.     

The wealth of nations revisited: Income and quality of life

Does economic prosperity enhance the quality of human life? Across 101 nations, 32 indices were analyzed that reflect a representative sample of universal human values (e.g., happiness, social order, and social justice). Wealth correlated significantly with 26 of the 32 indices, indicating a higher QOL in wealthier nations. Only suicide and CO₂ emissions were worse in wealthier societies. Basic physical needs were met early in economic development, whereas advanced scientific work occurred only when basic physical needs were fulfilled for almost all people in the society. Limitations of the conclusions are discussed.     

Infants' Behavioral Strategies for Emotion Regulation With Fathers and Mothers: Associations With Emotional Expressions and Attachment Quality

This study examined 12‐ and 13‐month‐old infants' behavioral strategies for emotion regulation, emotional expressions, regulatory styles, and attachment quality with fathers and mothers. Eighty‐five infants participated in the Strange Situation procedure to assess attachment quality with mothers and fathers. Infants' behavioral strategies for emotion regulation were examined with each parent during a competing demands task. Emotion regulation styles were meaningfully related to infant‐father attachment quality. Although expressions of distress and positive affect were not consistent across mothers and fathers, there was consistency in infant strategy use, emotion regulation style, and attachment quality with mothers and fathers. Furthermore, infants who were securely attached to both parents showed greater consistency in parent‐oriented strategies than infants who were insecurely attached to one or both parents. Limitations of this study include the constrained laboratory setting, potential carryover effects, and a homogeneous, middle‐class sample.     

The Metrics of Societal Happiness

Growing interest in the measurement of subjective well-being (SWB) has also been accompanied by scientific debate on the optimal method for measuring SWB. The momentary perspective, which is represented by the ecological momentary assessment (EMA) and day reconstruction method (DRM), emphasizes the momentary experiences and aims to measure SWB in an objective manner via the aggregation of happiness levels over time and activities. The global reporting perspective emphasizes the subjective evaluation of life experiences and aims to capture the overall evaluation using retrospection or global evaluations. We discuss the strengths and weaknesses of these different perspectives and methods by examining conceptual, methodological, and practical issues. We propose adopting a multi-method assessment approach to SWB that uses both perspectives and the corresponding methods in a theory-driven and complementary manner. For the purposes of measuring and tracking SWB of societies, we also call for more research on the reliability and validity of EMA and DRM.     

Working in caseload midwifery care: The experience of midwives working in a birth centre in North Queensland

BackgroundPregnancy, birth and child rearing are significant life events for women and their families. The demand for services that are family friendly, women focused, safe and accessible is increasing. These demands and rights of women have led to increased government and consumer interest in continuity of care and the establishment in Australia of birth centres, and the introduction of caseload midwifery models of care.AimThe aim of this research project was to uncover how birth centre midwives working within a caseload model care constructed their midwifery role in order to maintain a positive work–life balance.MethodsA Grounded Theory study using semi-structured individual interviews was undertaken with seven midwives who work at a regional hospital birth centre to ascertain their views as to how they construct their midwifery role while working in a caseload model of care.FindingsThe results showed that caseload midwifery care enabled the midwives to practice autonomously within hospital policies and guidelines for birth centre midwifery practice and that they did not feel too restricted in regards to the eligibility of women who could give birth at the centre. Work relationships were found to be a key component in being able to construct their birth centre midwifery role. The midwives valued the flexibility that came with working in supportive partnerships with many feeling this enabled them to achieve a good work–life balance.ConclusionThe research contributes to the current body of knowledge surrounding working in a caseload model of care as it shows how the birth centre midwives construct their midwifery role. It provides information for development and improvement of these models of care to ensure that sustainability and quality of care is provided to women and their families.     

Exploring e-Mental Health Preferences of Generation Y

E-Mental Health services could substantially increase the capacity of the mental health care system. This article explores youth consumer preferences for online interventions targeting depression and anxiety. Twenty-three participants who had experienced suicidal ideation and either depression or anxiety and completed one qualitative interview were included. Interviews were topically guided to cover themes of e-Mental Health service preferences around online help-seeking behavior, appearance, content, privacy, and support. We found that youth positively received the idea of, and appreciated the need for, e-Mental Health services. Noted preferences for services were those that are simple to use, interactive, and include support through an online community.